Healthcare, Fault, and Fat People

Bad DoctorOne of the ways that our healthcare system massively fails people is when healthcare providers presented with a patient who has a health issue focus on whether or not the issue is the patient’s fault.  This is something that happens to a lot of fat people.  Though thin people get all the same diseases as fat people, when a fat person goes to the doctor they can often expect to  hear a lecture about how their health issue is all their fault, or how they would be easier to treat if they were thin – sometimes in lieu of actually receiving treatment for their health issue.

I think that the concept of “fault” is sometimes used to veil fat bigotry in healthcare.  For example, when I go to the doctor now – no matter what my issue is – it is typically suggested that whatever the issue is, it comes from being fat and so it’s my fault since I ‘let myself get fat.”   Interestingly, when I was thinner I had any number of  injuries, all of which were “my fault” since nobody needs to do the jump splits, or play multiple sports, or train to run a 5k, or ski, or do anything athletic.  But no doctor ever suggested that since my injury was my fault I didn’t deserve treatment.

Here’s the deal – unless your doctor is The Doctor and has mastered time travel during your appointment which takes place in a Tardis, then as far as I’m concerned it doesn’t matter why someone has a health issue, it matters what healthcare the doctor is planning to give the patient going forward.

Assigning blame and fault have no place in healthcare and serve only to increase bias, and negatively impact healthcare treatment for the people being speculated about.

I think healthcare providers should treat the patient in front of them for the healthcare issue that they have using evidence based medicine and informed consent .  I would hope that healthcare providers who don’t have what they need to properly treat fat people would be on the forefront of activism to get the tools that they need to help their patients, not trying to hide their fat bigotry in talk about whose fault fat people’s healthcare issues are or how they could treat them if their bodies were smaller.

When you go to the doctor I suggest that you interrupt conversations about whose fault something is and instead ask that your doctor focus on providing you with evidence-based healthcare for the issue that you are presenting with.  Some phrases that I find helpful at the doctor are:

  • Do thin people get this health issue?  Can I get the treatment protocol that they get?
  • Can you help me understand how suggesting that I should be blamed for [my health issue] is part of your plant to help me get better? or I disagree that suggesting that I should be blamed for my health issue will help us to treat it so let’s please move on.
  • Can we please skip over who is to blame and focus on how we’re going to treat this issue?
  • Can you give me the name of a study of a weight loss intervention where the majority of people have lost the amount of weight that you are recommending that I lose and kept it off for the long term, as well as a study that shows that doing so would have long term positive effects on my health?
  • Studies from Yale have shown that over 50% of doctors have some prejudice against people of size – do you consider yourself part of that group of doctors?

Regardless, if you go for healthcare you deserve to get care for your health, not suggestions of fault and lectures.

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34 thoughts on “Healthcare, Fault, and Fat People

  1. This makes me remember a time when my gyno sent me to a gp for a referral back to him for a LEEP proceedure. He explained that if I had the referral, my insurance would cover the proceedure at a much greater amount and it was a small thing to go back-track and get that referral. At the time I had no gp… I’d go to a clinic for little stuff. So I picked a name from my insurance list and went to her office for the referral. Instead of just talking to me and getting the referral (my gyno had sent a detailed message to her office), she did a full new-patient work up and set about lecturing me on my weight and my ‘time-bomb’ of a heart (considering my family history and my weight)…blah blah blah. I got pissed.
    I said to her “did you even read the message from Dr. T’s office about this appointment? I’m just here for a referral so I can get my LEEP covered at a better rate through my insurance. What the hell does my weight have to do with my cervix!?” She was really pissy in return. Said I was ignoring important health concerns and that she didn’t have to give me a referral on just request alone. I told her that was fine, I’d go to another doctor for the referral.
    Since then I have made sure to tell anyone local about Dr. Feeler’s biases and attitude. Interesting since she was easily as overweight for her height as I was back then. Also, now I hear she’s in on the ground level of the weight-management/weigh=loss surgery clinic that is in town.

    1. I’ve not always been so pro-active for my own benefit. I’ve been blessed to have many very good doctors who are not weight biased at a level to compromise our dr./patient relationship. My gyno even refused me a letter of necessity for a weight loss clinic (in house) unless I could come back in a month and make him believe I wasn’t supposed to be a large, healthy, beautiful woman…just like I was right now. He probably saved my life, and definitely alot of money.

  2. ugh, all of this rings true. I need a new doctor, since I moved and haven’t had a checkup in around 2 years. But it’s been really hard for me to bring myself to go to someone, since I know this will happen.

    When I finally found someone, she immediately told me that my weight was a problem. When i tried to ask for studies, she pulled out the “well, i can’t name any but i know they exist” argument.

    The appointment ended with her telling me “I work in a wellness clinic. If you don’t have an interest in being well, I can’t treat you.” With, of course, wellness meaning being thin. SO FRUSTRATING.

    1. My friend got sent to a ‘Wellness’ clinic that was also a weight loss clinic. He went, and was surprised they were so misinformed and that most of the people there were middle age thin women afraid of becoming fat.

      He was telling me about it and I said to him. “Sweetie, what did you think they were gonna say? I told you, they would say all of that crap yesterday.” he was actually surprised a healthy obese person like himself would be sent there, I told him flat out had it been my doctor I woulda told him to shove it and find another one. I also told him had I gone, they wouldn’t like me too much either because I would be correcting them at every turn.

    2. I am so sorry this happened to you. I hear the phrase “wellness” going around too lately in disguise of diet/weight loss plans.

  3. Your mention of the “fault” issue – when athletes aren’t blamed for their injuries, reminds me…

    Many of my friends are Weekend Warrior Athletes. They don’t keep in training in the winter, their midweek warm weather activity is hit or miss – and then they go out and play hard and competitively on the first warm weekends. And, surprise, they injure themselves. And many – not all – of these injuries could have been avoided by a decent training program.

    One day at a party, a conversation I was in turned into a comparison of rotator cuff surgeries. (These were not Major League Pitchers abusing their bodies for the Big Money – these were accountants and salesmen on the same insurance plans the rest of us are on…) Others have blown knees, broken bones – and it is all taken for granted. Meanwhile, my insurance claims, over 30 years, have been for falling down a flight of stairs, and pneumonia, and I haven’t been in a hospital since I was four, but I’m the one society scolds for Costing More.

  4. I have somewhat mixed feelings on this topic. While I have also had fat blamed for a myriad of unrelated things–most recently a walk-in clinic doc who decided on sight that I was stupid when I came in for a follow up on an infected sebaceous cyst on my upper back–I do want my provider to try to sort out *cause* if they can.

    If I go to a health care provider, whether that be for mental or physical health, I want them to deal with the cause of the issue whenever possible so that condition can be cured or improved in the long term. As with my cyst, the short term fix is antibiotics. The long-term fix requires getting at the cause, and in this case surgical removal. Otherwise I’ll be back in a year or two with another infection. If I’m depressed, the “cause” may be a simple chemical imbalance, or it may be that I won’t improve until I address an adverse life event (death, abuse, etc.). Whether mental or physical, this needs to be a collaborative process–I may want more information, I may need to add information based on their feedback, or I may simply be unable/unwilling to accept their first recommendation in which case we need to try plan B (or C or D!).

    So, I agree that doctors should treat the illness and patient before them *today*, I agree that prejudice should not impact treatment–in fact as a clinical social worker I’m ethically required to examine my own prejudices and refer clients who I cannot appropriately treat. I demand a respectful conversation from my providers. But I do want them to look for root causes. A good provider will do it with skill and an open mind so that it does not slide into blame…

  5. Your blog has really helped me to think more critically; thank you. My gym has a TV with various messages that run across it all the time. One of the messages is “Studies show that obese people take more prescription medications. The prescriptions are for diseases like high blood pressure, cholesterol, etc. etc.” And every time I see it I want to scream that being prescribed more medications is just evidence of doctors’ bias against fat people, not that fat people are actually more sick. Arghh.

      1. That is so true Tara – I am on 3 to 4 meds that cause weight gain…but, that should not matter. I should be able to lose weight anyway.

      2. Oh, didn’t you know that no medicine causes weight gain? It’s just that some medicines make you lose self control and eat more, or they make you auto-snack without realizing it, where did I put that sarcasm tag? Yes, my old psychologist I was seeing for depression said this crap to me.

  6. My father got lung cancer from working in the engine rooms of ships during WWII, which gave him asbestosis, which eventually morphed into mesothelioma.

    My mother-in-law got lung cancer from more than fifty years of chain smoking… though she attributed it right up to her dying day to the Nagasaki bombing she survived as a young girl.

    You know what? Both of them needed and got evidence-based health care for their lung cancer without a lot of blaming or shaming.

    They were sick. There were treatments available for their illnesses. They were given what treatments were available and appropriate, based on the disease they had, the stage the disease had reached when diagnosed, and any other factors directly involved.

    Sadly, both of them lost the battle against lung cancer. But if anyone had told me it was all my mother-in-law’s fault that she got cancer and she shouldn’t have gotten just as good care as my father did, yeah, I’d have given them a well-earned dish of whatfor followed by a boot to the rear for dessert.

    Both my father and my mother in law suffered from their final illnesses. They both needed evidence and caring to help them in their final days.

    You know what doesn’t cure and doesn’t damn well help? Telling patients they don’t deserve treatment because they brought it on themselves.

    1. Abso-freaking-lutely. How someone got a disease (even if you know, and because risk factors are so many and complex, you usually don’t) should not bear any relationship to how effectively and compassionately you treat them. Blaming is the absolute worst thing you can do to someone dealing with a serious illness . And despite what some medical people think, it’s not really that great a preventative measure either. I’m sick of reading about women with breast cancer and their relatives are saying ‘She exercised, she ate right, she was thin, she didn’t deserve to get this…’ No, she didn’t, not because she did everything right, but because nobody ‘deserves’ cancer. Ick.

  7. This issue is one that REALLY pisses me off! Sadly, I think it’s only going to get much worse in the United States. I see story after story on the news about the “obesity epidemic” and what we can ALL do to stop it, or fix it! I’ve seen commercials (like from Coca-cola) outlining what they are going to do and that we all need to do our part to fight obesity. On and on and on.

    With this new Obamacare healthplan, I think that obese people are going to be penalized – either with higher costs, or less treatment – until we can get the weight off. Amazing to me is the fact that there are absolutely no studies to prove better health in the long run. No facts that show people can lose weight for good. I don’t know about any of you, but I will NEVER go on a diet again. I am not going to lose 150+ pounds, only to gain 170 back. My body cannot take another round of that.

    These people call us weak and undisciplined – I’d like to see them go through the things that we all have. They aren’t faced with trying to be something that they weren’t born to be. It’s just ridiculous. I am almost to the point where I feel like it’s hopeless and just a matter of time before I become “Public Enemy #1!”

    1. I feel the same way you do as well. I can’t take the hatred directed at me either. And I also question whether the thin people hating on us could go through the diets and hatred we’ve gone through.

      1. Exactly kprofou, I would like to see if one of these “experts” has what it takes to lose over 150 pounds. To not deviate from the path for well over 5 years and to exercise to the point of having to have both knees replaced due to wearing all the cartilege out of both of them.

        Not only that – but the years and years we have had to put up with taking crap from friends, family and every other person that ever came into contact with us. It’s a miracle that we haven’t all lost our minds by now. I’ve been close, but still manage to hold on!

        I am so thankful for blogs like this one – that helped me take the “blinders” off and see that my body is just not capable of being a size 5. I have adjusted my thinking and my expectations and now I can appreciate the things that my body is capable of doing and be thankful for that every day. No more waiting to live life when I finally become thin. It was so ridiculous that I thought this way for over 45 years. What a waste of time!

        Just heard on the radio – Chris Christie’s appearance on David Letterman is being discussed – some expert came on and said that even though he has normal cholesterol, blood sugars, etc., Chris Christie will still die at least 10 years earlier than he would have if he were thin. Being morbidly obese, she said, cancels out the fact that all his blood readings are normal. Some expert!

  8. Here’s what I don’t understand– even if your injury is 100% your fault, what’s the point in having a big ol’ blame session? I mean, if you’re 12 and you jumped off a roof and broke your arm, then yes, a parent or guardian should probably talk to you about not jumping off the roof in the future. But the majority of the time we’re talking about long-term health conditions with no clear or fast cure: cancer, heart disease, diabetes, arthritis, etc. And once you have cancer, what’s the damn point in sitting around telling your patient “this is all your fault!” Really? I didn’t realize shame was the secret cure for cancer and all else that ails ya. I mean, jeeze, Diagnose and Treat. End of story. What ever happened to “first, do no harm”?

    1. I totally agree with you about the blame game. However, there are circumstances in which it is appropriate for a doctor to address the cause of a condition, even a long-term one–it wouldn’t be out of line, for example, for a doctor to advise a lung disease patient to stop smoking. Not only can this be key for the success of treatment, but it can also be important to prevent remission or complications. A doctor’s job isn’t just to diagnose and treat; it is also to prevent relapse and to help a patient be proactive about their health rather than reactive. It’s absolutely a doctor’s concern to address risk factors they feel will interfere with treatment or are simply going to result in a recurrence, even if treatment is successful.

      The problem is that many doctors (heck, many people) are unable to address cause without also assigning blame and shaming. Another problem is that in current medical practice, obesity is viewed as “the cause” or “an obstacle” more frequently than is true. But these things don’t mean that a doctor who tries to address cause in order to make sure treatment is more effective or prevent a relapse is out of line; that is exactly how I would hope my doctor would behave; I would just also want them to do it with respect for both me and facts.

      1. Though there are perhaps situations where cause should be addressed, though I think it’s very rare – especially since we can almost never determine the cause for certain. People who never smoked get lung cancer as well so we cannot prove the someone’s smoking caused their cancer and there is nothing to be gained by suggesting that it was, because regardless of the cause it’s still about what will be done in the future. In your example, all patients with lung cancer are encouraged not to smoke – for some that means stopping and for some that means not starting but it doesn’t matter whether or not they previously smoked or whether or not that caused their lung cancer, it’s still about treatment and future behavior.

        Calling “obesity” a cause is even more complicated because it’s a body size and not a set of habits or behaviors, and suggesting that someone wouldn’t have gotten a disease if they were thin is more than problematic when thin people get all the same diseases as fat people. So even if we think that determining cause is important suggesting that body size is a cause is still a major issue.



        1. Oh, I agree, which is what my last paragraph was about. I simply objected to the idea in the comment I was replying to that the only role of a doctor is to diagnose a problem already present, treat it and only it, and stop. There is a lot more to general practice than that.

        2. There has been a recent rise in lung cancer in non-smokers, but lung cancer continues to be one of the most underfunded cancers researched because it’s victims are blamed for the illness.

  9. If our doctor was The Doctor, not only would he cure our ailments and probably not care what we looked like, he’d also protect us from evil space enemies at the same time!

  10. Loved the Dr. Who reference! I have a terrific Doctor who does not mention my weight, She focuses on what is happening to me at the time. It took a long time to find her however and I have had some really biased Dr’s before. Thank you for sharing this info!

  11. My doctor is also one of the awesome ones who told me off for worrying about my weight until she sorted out my other problems. I told her that I delayed reporting symptoms because I thought they were just because I was fat and she just told me off for being silly! I really value having a doctor that doesn’t attribute physical problems to being either caused by fat or crazy!

  12. I’m dealing with the blame game right now, courtesy of my father-in-law. My husband (mid-40s) had to have an angioplasty last week. Which FIL has decided is the fault of me, the fatty fat wife, who obviously stuffed fatty food down DH’s gullet. I also jumped into a TARDIS, sped back in time, gave DH a genetic predisposition to high cholesterol, forced him to deny/ignore the high cholesterol diagnosis he got almost 25 years ago and was warned repeatedly about by doctors over the years, and got him started smoking in high school (he finally quit 5 years ago).

  13. A minor triumph for me today: I went to urgent care to be checked out following being hit on the head. After establishing that I was fine, the doctor said, “And now, how are you doing with your weight?” I simply looked at him and replied calmly, “I’m not here to discuss my weight.” He even apologized if he had offended me. Thank you, Ragen and other SA/HAES bloggers, for giving me the tools and the courage to stand my ground.

  14. I agree that some doctors oddly dismiss certain lines of thinking, even with pressing by the patient themselves. My sister has pernicious anaemia and uses up her B12 injections super fast causing fatigue and nerve issues. However, despite a pressure group campaign for more frequent injections (which cost pennies to the UK NHS), she’s been referred to a psychologist as her gp insists she’s just depressed…I hadn’t appreciated the issues that larger people go through and I will certainly do so in future.

    In my own mind, if you’re living a healthy lifestyle, bigger folks can be as healthy as an ultrarunner. Its when we don’t look after ourselves, that lack of or excess weight seems to become the straw that breaks the camels back.

    Thing is, how can larger people be encouraged to enter into healthier eating and exercise for its own sake without feeling that its an attack on them and their weight or being patronised?

    1. I think we need to separate size and health. Healthy habits are healthy habits no matter what someone’s size. I don’t think that people with fat bodies are in any more need of “encouragement’ to be healthy than those with thinner bodies. Especially knowing the statistics of diet failure, I believe that we should be careful when assuming that those who are larger aren’t eating healthier or exercising or that those with thin bodies are – that’s not something that proves out in reality. I do think that everyone should be given easy access to true information as well as options for food, movement, and healthcare and then have their choices about their bodies respected.


  15. This all rings so true with a recent injury. Going about normal every day activities, I took one step down a staircase, and then had agonising pain in my left knee. So I went to the doctor, who suspected, with my family history that I may have torn a ligament, and to come back in a week if it still hurt. I then had a fall, and, worried, I went back, but the original doctor was out, so I saw a different one. And he said this:

    “Well when you’re extremely morbidly obese, of course your knees are going to suffer! It’s a bad strain being exacerbated by the weight of two people on a single set of knees! The real problem we must treat is your size. Now, obviously you aren’t willing to apply yourself to a diet and exercise regime, so we must look at gastric bypass. If we don’t fix this now, you’ll have arthritis at 30, a knee replacement at 40, and be dead before your 50th birthday. So, shall we put you on the waiting list?”

    I tried to back out completely, but he said “consider it” and put it on my notes anyway. I’m 18. Same doctor previously suggested stomach amputation when I was 13. So I refused to see him, and never will again.

    But that’s not the end of it. The nearest hospital point-blank refused to even see me unless my BMI was under 30. Then I had to go to one 50 miles away to be seen within the next three months. They fitted me with a brace that didn’t work, and when i called them up about it they said “these things don’t tend to work at the extremes of their capacity” and “of course it won’t work if your thigh is twice as wide as your shin (its not)” and therefore fitted me with a cast, making sure to exaggerate the whole time the amount of material needed and how they’d have to put the foot in the cast too because of my “frankly massive” proportions.

    It’s the nearest I’ve come to thinking about dieting again. But instead, I picked myself up and moved on. I can’t be transferred, or they have to start the whole treatment process again from referral, so I’ll have to weather the storm.

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